Table 3

Examples of how implementation outcomes have been applied to implementation research to evaluate specific implementation strategies in global health

Example of research studyImplementation strategy (ies)Implementation outcomes assessing effectiveness of implementation strategy
A stepped-wedge cluster randomised trial evaluating the effectiveness of a novel vital sign device in detecting pre-eclampsia and shock to improve maternal mortality or morbidity as well as implementation effectiveness in 10 countries across Africa, India, and Haiti.98 The RE-AIM framework was used to evaluate implementation outcomes.41Task shifting with community health workers to overcome lack of trained nurses and doctors to detect and treat pre-eclampsia,
Education and training to improve skills to accurately detect and treat pre-eclampsia.
Coverage—Difference in proportion of women with blood pressure measurements pre and post implementation;
Fidelity—no/proportion of sites that delivered the training as intended;
A study protocol for a randomised controlled, non-inferiority trial aims to test the effectiveness of using general health workers to deliver mental healthcare in primary healthcare settings, compared with specialist medical care delivered by psychiatric nurses for patients with severe mental illness.100Task shifting using general healthcare workers to overcome lack of specialist medical care and improve the proportion of patients receiving effective treatment.The fidelity of the task shared mental healthcare in delivering the guideline-based care, was measured through structured evaluation of clinical follow-up forms by independent psychiatrists, including prescribing, risk assessment, psychoeducation and symptom review.100
A process evaluation of a primary care paediatric intervention (Practical Approach to Care Kit (PACK) Child) piloted in 10 healthcare clinics in the Western Cape, South Africa. PACK Child comprised clinical decision support tool (PACK Child guide), training programme and health system strengthening components.101 102Education, cascade training model, supervision with regular updates as guidance and policies change.Implementation fidelity—Use of the PACK Child guide according to training programme.
Acceptability—Stakeholder perspectives of impact of the intervention on child healthcare.
  • RE-AIM, reach, effectiveness, acceptability, implementation and maintenance.